December 13, 2017
The Power of Hope
Be Well

The Power of Hope

by John Swartzberg, M.D.  |  

Every few years I write about the placebo effect in this space because it’s such a crucial—and potentially confusing—player in health and wellness. The word placebo pops up just about every month in the Wellness Letter. It turns up a dozen times here in our article about acupuncture.

How much do acupuncture’s apparent benefits derive from the placebo effect? That’s a key question about most complementary and alternative therapies—but also about much of mainstream medicine. Researchers and doctors have a love/hate relationship with the placebo effect. While we want to encourage it, we don’t want the benefits of our treatments to derive solely from the placebo effect. But does it really matter? And what is this mysterious phenomenon?

The placebo effect occurs when belief in a remedy or in the power of a trusted and caring practitioner actually helps the remedy work and triggers an improvement in symptoms and health. A placebo (Latin for “I will please”) is a “fake” or simulated treatment, such as a dummy pill or sham procedure, administered to someone who is unaware that it’s not a “real” treatment. As far back as ancient times it was known that the hope and expectation people experience when treated—even with a placebo—can play a large role in recovery. When it comes to pain and many other phenomena, the mind and body work together.

That makes it hard to tell to what extent beneficial results come from a treatment itself or from the patient’s positive expectations. But it’s essential to know whether the apparent efficacy of a treatment such as acupuncture is due solely to the placebo effect. The only way to find out is to test treatments against a placebo in controlled clinical trials, in which neither the researchers nor the patients know who is getting the treatment and who is getting the placebo. Even with a drug or procedure that’s more effective than a placebo, a patient’s hope and expectation that it will help can add to its effectiveness.

It’s estimated that anywhere from 10 to 40 percent of people given a placebo show some improvement for a variety of symptoms or conditions. This effect is more likely to occur when people believe that someone is trying to help them and thus expect relief, and especially if the someone is an optimistic practitioner in a therapeutic setting.

Placebos have a bad reputation because they involve deception. If I prescribe sugar pills for patients with migraines, they may have less pain for a while, but I have deceived them. Doctors are obliged to try to cure the ailment, not merely make patients feel better temporarily. But often we do both, and sometimes the latter is the best we can do. Some patients may not care if they are secretly given a placebo, so long as it helps. However, others would lose trust in their doctors if they found out. And without trust, even proven treatments may work less well.

But things are not always black or white—placebo or effective treatment. For instance, even after reading dozens of studies and reviews about acupuncture, I’m not sure how beneficial it is beyond its strong placebo effect. Still, when I was in practice I sometimes advised acupuncture and I would still do so today—at least for patients with conditions such as back or neck pain that isn’t alleviated by conventional treatment, or nausea caused by chemotherapy.

The trick is to harness the placebo effect as an ally in healing—for treatments that are of proven efficacy as well as for those of uncertain efficacy.